TIR and Autism Spectrum Disorder

Cathy Dodge Smith, CTIRF

Portrait of Cathy Dodge Smith — Cathy Dodge Smith

Cathy Dodge Smith uses Davis Methods in her practice (Davis Dyslexia Correction® Program, Davis Autism Approach®, and Davis Attention Mastery™ ). She is also a Certified TIR Facilitator. This article is from her presentation at the 2014 Symposium and was featured in the AMI/TIRA Newsletter (Vol. XII, No.1) March 2015

In my practice as a Davis Autism Approach Facilitator and Coach, I provide clients with tools and techniques to allow and empower them to learn. I use the Davis approaches because they actually correct dyslexia, attention deficit disorder and autism without medication. At our center, we help our clients find and clear up triggers. A trigger is what we call anything that contains enough confusion or enough emotional charge to lead to disorientation. In a disoriented state, a client is not focusing, or not paying attention, and not aware of the true facts and conditions in his or her surroundings. When that happens, perception is inaccurate, which, of course, makes learning very difficult. So, that’s what we do.

Let’s start by looking at how autism is defined.

First we should note that Asperger Syndrome used to be the label given to high-functioning people with autism. Now these phenomena are considered all part of Autism Spectrum Disorder.

The most well-known and evident manifestation of autism is failure to develop what we would consider “normal or typical” social relationships. Symptoms may be severe, as in children who spend most of their time rocking, twirling objects, fiddling with things, or staring off into space–just really not here in this world. Or the symptoms can be quite mild, as in someone who is highly verbal, can have a conversation, and can interact with people, but still spends a lot of time in his or her own world as well.

Thus, one of the real hallmarks of autism is the social behavior of people on the autism spectrum. At the high-functioning end of the spectrum–what used to be called Asperger Syndrome–the behavior is just seen as a little a bit odd. For example, Joshua, one of my clients whom you’ll be hearing more about later, is a nine-year old I worked with recently. He was very concerned about being called a nerd at school and very angry about that. He just didn’t understand that when a nine-year old boy goes to school with his stuffed animals, and sucks his thumb, and talks incessantly about drums, the other kids are

pretty much going to think he’s a nerd and they will call him a nerd. That kind of unusual or odd behavior usually causes those children to be shunned or excluded and they don’t like that.

All individuals on the spectrum will display many of the characteristics on the following list[1] to a greater or lesser degree. No individual will have all the characteristics.

Is not interested in social activities of peers: This often becomes evident as the child begins school. Before beginning school, they can usually get away with it. The autistic individual perceives other kids as not ever wanting to do or talk about interesting stuff, and therefore finds them boring. Individuals with autism often don’t ‘get’ what other people consider normal.
Does not seem to understand social situations and conventions: For example, no matter how many times reminders are given, greeting people or saying good bye when leaving don’t become automatic or natural behaviors.
Often gets along better with older or younger children than with age peers: . It is quite well known that children have a kind of built-in radar to understand what is normal for kids their own age. Children know what’s considered typical for their own peer group, but they have already forgotten what was typical for younger children and they don’t know yet what’s typical for older children. So, they accept the differences in kids that are older or younger than they are as “that’s just the way teenagers are” or “that must be the way younger kids act.” So, children on the autism spectrum tend to get along better with people older or younger than they are, who tend to accept them more readily.
Has a high level of interest in one or more areas but limited interest in topics of interest to peers; doesn’t seem to know how to share interest: To illustrate this, I’m going to summarize a case from a book by Tony Attwood called, The Complete Guide to Asperger Syndrome. (Apparently, he didn’t get the memo about the change in terminology, but it is a really wonderful look at autism.)

It is the day of Alicia’s birthday party. The doorbell rings and Alicia’s mother opens the door to find Jack, the last guest to arrive. The invitation list had been for ten girls and one boy. Alicia’s mother had been surprised, thinking that girls her daughter’s age usually considered boys to be stupid, but Alicia had said that Jack was different. His family had recently moved into the area and though he had tried, he hadn’t made any friends. Alicia thought he was a kind and lonely boy who seemed bewildered by the noise and hectic activity of the playground. He looked cute –a younger Harry Potter; and he knew so much about so many things. Despite the perplexed looks of her friends, she invited him to her party.

Jack was holding a birthday card, with writing strangely illegible for an eight-year-old, and a present, which he immediately gave to Alicia’s mother. “You must be Jack,” she said. He met this with a blank face, “Yes.” She smiled at him, and here I will quote Jack to give you the feeling for his stab at social interaction: “Alicia’s birthday present is one of those special dolls that my mum says every girl wants, and she chose it, but what I really wanted to get her was some batteries. Do you like batteries? I do, I have a hundred and ninety-seven batteries. Batteries are really useful. What batteries do you have in your remote controller? I have a special battery from Russia. My dad’s an engineer and he was working on an oil pipeline in Russia and he came home with six AAA batteries for me with Russian writing on them. These are my favorite. When I go to bed I like to look at my box of batteries and sort them in alphabetical order before I go to sleep. I always hold one of my Russian batteries as I fall asleep. My mom says I should hug my teddy bear but I prefer a battery. How many batteries do you have?”

Jack continued to provide a monologue on batteries; how they are made and what to do with them when the power is exhausted. Alicia’s mother felt exhausted too, listening to a lecture that lasted about ten minutes. Despite her subtle signals of needing to be somewhere else, and eventually saying, “I must go and get the party food ready for the party,” Jack continued to talk. Alicia’s mother noted that it was more like listening to an adult than a child. Jack spoke very eloquently, although he didn’t seem to want to listen.

Atwood goes on to describe what happened when Jack went out into the garden, still talking about batteries to the other children. One of the kids tripped him and he fell and Alicia came and gently helped him up. That would be a pretty typical scenario for a child with autism in a social setting.

Problems with motor coordination: That affects things like printing, catching a ball, and running.
Over-reacts to some stimuli such as specific sounds, smells, some foods, the ways in which foods are presented on a plate, or some textures: For example, a relative of mine with autism used to put his hands over his ears in church every time the organ was played, even though it wasn’t particularly loud. He’s the only child I’ve seen in 30 years in that same church who covered his ears every single time the organ was played.
Comfortable with routines and anxious when routines are changed: They may be insistent that toys are left in exactly in the same place. There is a lovely, and typical, example of this in a novel about autism by Jodi Picoult, called House of Rules. The main character in the story would only eat food of a specific color for each day of the week. So, Thursday was Yellow Day and nothing that wasn’t yellow would be eaten by that child, or could be served to anyone else anywhere near him without provoking a huge tantrum. Veronica, about whom you’ll hear a little more later, likes pizza, but only a particular brand, and only cheese pizza. If you try to give her any other kind of pizza, she will not eat it.
Problems with attention regulation and learning at age-appropriate pace: For an example of this, I will tell you about Charlie and The Grinch. Charlie is one of the clients I’ve worked with. He was sixteen at the time and spent most of his time reviewing in his mind his favorite movies, videos, and TV programs. It didn’t take me long to figure that out because The Grinch was his very, very favorite. When I was sitting across the table from him, I would hear the full sound effects of The Grinch movie: the dialogue, the music, AND the special effects. Sometimes he would try very hard to pay attention and so he would sit very quietly and look at me every now and then while I talked to him about the meaning of ‘consequence’ or some other concept. Then, all of a sudden, he would screech, “Ahhhhhhhhh !” scaring the daylights out of me. Then he’d say, “Oh sorry, I did it again, didn’t I?” The sound I heard was the voice of the Grinch at one point in the dialogue and that’s where Charlie was in the movie. Of course, his parents repeatedly told him that The Grinch was inappropriate for a sixteen-year old to be wanting to watch, which only upset Charlie.

~ ~ ~

Colin, another little fellow, was seven when I worked with him. At first, he would spend most of our time together wandering around my office touching things, opening and closing drawers and doors, looking at things, talking non-stop to me. He would ask me questions just like Jack did in the story earlier, but never waited for an answer. Every now and then, he’d come over and stand beside my table and say, “What are we meant to be doing?”

I’d say, “Well, what I’d like you to do now is sit down in that chair and see if you could make a little person out of clay.”

“All right,” he would say and he’d sit down. He’d start working on a little clay person, and then away he’d go for another hour, and then he’d come back and say, “Right, what are we meant to be doing?” I’d say something like, “What I’d like you to do now is …”, to get another five minutes of his attention. As you can see, the attention span of an autistic child can be extremely limited.

Colin had an invisible car and every time he started getting nervous, his little hands would come up and clutch the steering wheel. He would become very angry if he heard his mother refer to it as an imaginary car, and would correct her vehemently. “It is not imaginary! It’s invisible! Get it?” For the first long while I was working with him, every time he made a new model of himself, which he did quite frequently, he would put it on a clay mat. The day he made a model of himself and it didn’t have a mat to stand on, I thought, “Whew, he’s feeling much more secure now.” The length of time he was able to stay focused and work with me increased daily. I believe the reason that happens is that we do not try to encourage, force, coerce, manipulate, or motivate clients to stay with us and work for “just a little longer.” We accept what they give us, and make it clear that we will be there waiting for them when they are ready to come back and continue working. I believe that gives them the feeling of safety they need to be willing to stay “in this real world” a little longer each time.

Often hyperactive–at least in some situations: This may be expressed as difficulty sitting still, difficulty delaying gratification, interrupting others, and difficulty resisting impulses to touch and examine things without permission.
Delayed in development of speech and/or has problems using speech in socially appropriate ways: They may sound like a little professor (like our Jack with his batteries), but have real difficulty in an actual conversation.
Difficulty with abstract language, figures of speech, or similes, or anything that’s not really concrete: An example of this happened with Douglas who was about twelve at the time. One day when I first began to work with him, he was in the car with his mother and they were having some kind of major altercation about a comb. He was perseverating [ Note: to perseverate is to repeat something insistently] and just wouldn’t accept whatever his mom was telling him. She finally said to him, “Oh, for goodness sakes, Douglas! Just drop it!” So, he physically dropped the comb. She said, “You don’t need to be smart about it.” He said, perplexed, “What? You told me to drop it.” “I didn’t mean drop the comb.” his mother answered. He was truly perplexed, thinking, “Okay, she just told me to drop it and now, she’s mad at me ’cause I dropped it.” He just didn’t get that.
Often seems to be on a high level of alertness or anxiety: This, of course, can make autistic individuals very defensive. I’m sure as TIR facilitators you are familiar with that.
Has a strong sense of justice and may refuse to follow rules that seem unfair, or may refuse to accept authority if own logic or interests seem compromised: Needless to say that’s a bit of a problem in schools.
Perseverates on some idea and cannot seem to let go of it or change the activity or topic: Refer back to Jack with his batteries and Joshua with his drums.
May have an unusual attachment to an object and requires its presence for comfort. Ron Davis, who developed all of the Davis programs I use and who is himself a person with autism, calls it “a familiar.” He often has a stone or something in his pocket that he can feel. Many of the clients I’ve worked with have one particular object they like to have with them all the time.
Has significant problems with adaptive behavior, especially with regard to anger management, anxiety, and depression: Families of autistic children are all too familiar with the phenomena referred to as “meltdowns.” Those can be prolonged bouts of crying, yelling, tearing around, arguing … just some kind of really distressed behavior.

TIR and the “Little Window in Time”

Now let’s consider why TIR would be expected to be different with an autistic client. One of the hallmarks of autism is a lack of connection with the real world, so the world view of an autistic individual is limited and often very inaccurate. A second hallmark of autism is difficulty with intrapersonal and interpersonal relationships so that insight into how to make relationships better, or work at all, would be expected to be limited. So, within a TIR session where we expect our clients to come up with their own insights, that’s really a tall order. Then the meltdowns I’ve talked about; as a Davis facilitator I understand these as prolonged and severe disorientations, analogous to a PTSD episode, in which the emotional reaction is really out of sync with true facts and conditions in the current situation. Added to all this are the phobias and the extreme aversions that many autistic individuals experience, which can limit full participation in life.

One of the things that makes working with autistic clients challenging is that often we simply have to wait until they give us that little window of time when they are able and willing to proceed. If I were to use the guidelines in my TIR Workshop manual, I would have to conclude that there was not enough ego strength or resiliency in these individuals for them to be able to engage for a successful TIR session. You know what they say about fools who rush in where angels fear to tread… A less foolish person than I am, and especially someone new to TIR, would likely never have tried to use TIR with autistic clients. However, based on the wonderful results I have seen using TIR with many of my other clients who do not have autism, and some of the really significant problems that some of my autistic clients were presenting, I decided to try TIR with a few of them.

The first one was Veronica. She was a sixteen-year old who basically lived as a recluse in her mother’s basement. Her major goal in her work with me as a Davis Autism Approach Program facilitator was to be able to go to a mall. Every time she was in that kind of setting, she would have such a severe panic attack that she simply had to leave immediately. For a sixteen-year old, that is pretty much a life-threatening disorder. School was out of the question for her. She actually had been removed from her mother, who was a single parent, because of her refusal to go to school. The authorities figured there was something the mother must be doing wrong. She was removed from her mother for quite a period of time at one point in her life, but she still was not able to go to school at all. We were able to deal with the mall issue through the normal use of our Davis tools and the de-triggering procedure of the Davis program.

As an aside here, I’ll briefly describe these tools that are integral to the Davis programs. The first one is orientation. We understand that disorientation is at the root of dyslexia, ADD, and autism; disorientation meaning “not fully present.” Based on our assessment, we find the best way to help each individual client to learn how to become oriented and learn how to recognize when they’re disoriented so they can become quickly and easily oriented again. The second is release, and that’s a very quick easy relaxation technique using breath and physical releasing of tension. We teach them that technique to help them let go of tension and frustration, anger and anxiety. The third is the energy dial, which allows them to become aware of their own energy level in comparison with the energy level of others around them, and to be able to monitor their energy level so it’s appropriate for the situation. This is extremely powerful for hyperactive or hypoactive clients. It really does allow them very quickly learn how to manage their energy level, in contrast to the years, and years, and years that they’ve had people saying to them, ‘Calm down’, ‘Settle down’, ‘Relax’, or ‘Chill’ when they didn’t know what that meant, nor how to do it. So, we teach them how to do it.

Back to Veronica and some of her phobias and issues. An even more intransigent issue for her than malls was her great fear of trucks, especially big trucks, especially blue tractor trailers. Even hearing a truck made her extremely anxious so that just walking down the street was hard. That was one of the reasons why she was living as a recluse, because being outside was just too scary. That fear was bottled up with her anger with her father, a truck driver, with whom she had not lived since she was under the age of four and whom she had refused to see or talk to in all the years since. She just wouldn’t. So, we did an Unblocking session about her father. We went through the list and as she answered the questions she gave the appearance of being at the apathy level of the Emotional Scale. Nothing appeared to be happening and I was thinking, “ Okay, this doesn’t work very well for her.”

At one point, she paused and said, “Do you think it’s childish to just blame your parents for everything?” And I said, “Well, I don’t think it really matters what I think. It probably matters more what you think.” She thought about that and then she said, “Okay”, and we went on and finished the Unblocking. At the end of it, I still thought that nothing much had happened, because even when I asked her the question, “What have we accomplished?” she just shrugged. That was it.

A few weeks later, I heard from her and her mother that she had agreed to see her father, they had gotten together, and they had gone to a mall together. He had bought her one of her favorite games, and they had a good time. I had done some work with her mother this past week and she told me that when she got home from a weekend away, the first call she had was from her ex-husband who was just over the moon… happy because for the first time ever, his daughter had returned his phone call.

And then there’s Joshua, my little drummer. He was given to periods of extremely oppositional behavior. He was very resistant to most of the work I was doing with him but he was willing to come back every day and his parents thought that was something of a minor miracle. At that time he was attending a special school with very small classes for children with neurological disorders. In addition, he had a one-on-one teaching assistant his parents were paying extra for all day, every day. Even so, they kept getting calls that they’d have to come and pick him up because he was so destructive and so disruptive that no one could work with him in the classroom. In the beginning it wasn’t much different in my center. At one point, he deliberately took a roll of toilet paper, put it in the toilet, and then flushed the toilet so we had a nice little flood that day. I have little doorstoppers in the door frames for all the doors so that when they close, the noise won’t reverberate throughout the center. He repeatedly picked every single one of those out and put them in the garbage. He was forever trying to get at my computer or the office administrator’s computer, and unplug the telephones. He smashed things; he was really, really disruptive and destructive and talked incessantly about drums.

He is a phenomenal little drummer at the age of nine and that’s all he wants to talk about. The minute the door of the center opened, I could hear him, “I don’t know whether it’s better to have six high-hats [cymbals as part of a drum set — Editor] or five … what do you think? Mine only has five. Do you think that’s enough?” he would go on and on and on without listening to any answers.

One day, Joshua was being destructive and I could see him becoming really angry. Part of the work I do with my clients is to have them make models out of clay and then form clay letters on the table to spell the word of the concept we’re working on. That’s part of the mastery process. Because he was very resistant to just about everything including working with the letters, I was actually making the letters for him so that all he had to do was place them in sequence, and he could see on a card how the word was spelled. There was nothing at all difficult for him and yet there was this resistance. So, this day, I said to him, “What is it about our work that seems to make it so hard for you?”

“It’s the word,” he said.

“But you don’t have to make the letters or know how to spell the words anymore,” I argued.

He exploded, “I know, but they’re still letters and they’re still words and I hate words! I hate words!” That was that, and he ran off all around the center. I followed him.

“What is it about words? Tell me about words,” I said. He went on and on zigzag, zigzag, and I just followed him wherever he went. He tried to throw a computer on the floor. I held it and I said, “Tell me more. Tell me more.” It was essentially the Conversational Remedy from the TIR Workshop Manual — on the fly!

Finally, he told me, “When I was four years old, my teacher hit me.” I then switched to Basic TIR, saying, “Tell me what happened.” By this time, his mother had come to pick him up, and in response to my silent direction to her, she sat quietly in the waiting room. He told me about a time when his teacher yelled at him. Joshua continued to yell, cry, move around in a most agitated way, and tell me about that episode. He went on and on about the incident of the teacher hitting him, and then started telling me that his mother hit him too. She started to say something, but responded to my signal that she should remain silent, and we switched to TIR on that event. He went through it several times, and occasionally went back to the teacher incident or other ones. Each time he switched to a new incident, I went with him and continued asking him to tell me about it as long as he was willing to do so. At one point he went into an empty office and drew a picture for me on the whiteboard of his teacher yelling at him. Finally, he just screamed, “I don’t know why. It’s all just twisted up in my head with letters equals work equals punishment equals hitting equals Mum and I don’t know why! It’s always that way!”

I said, “Oh, thank you. Would you like it not to be so hard for you?”

“Yes, I would,” he answered in a much calmer voice.

I said, “I think Mr. Desmond can help you with that. Would you like him to try?”

“Yes, I would,” he answered very calmly.

That was the end of that day’s meltdown. He did go on to work with Desmond (who works with me) in our Dyslexia Correction Program to de-trigger letters.

Joshua’s mom told me later that she had found out a couple of years after the fact that in his preschool, one of the teachers in particular had been — to put it gently — unkind to her son, hit him and locked him in the closet one day, and threatened him. The mother had, in fact, hit him once in absolute frustration (I totally get that), but once and only once. She has been and is a model of kindness and patience with him, but that one time got all messed up with the teacher and all those school experiences. Every time he had talked about his mother hitting him, she would remind him that it only happened once, and that she had apologized to him, and would try to diffuse his feelings about it. We understand that, but we also know it can leave the event unresolved. This TIR session took place in June, 2014.

In the fall of 2014, as a result of all the work he has done with us, Joshua was in a regular class in a regular school and doing well.[2] He came in to my center the second week of school, not to see me, but to see someone else who works there. He came springing into my office and started telling me about school.

He said, “Today was a stressful day. It was just full of stress, but I held it all inside.”

His mom told me that she could see when she went to pick him up that he was very close to the edge, but as they left the school, he held it together. When he got into the car, he started to cry, but that’s all he did. It wasn’t the usual huge tantrum meltdown and he was able to tell her about what was stressful at school. I think that was pretty interesting.

I would like to share one more case story. This was an adult client who had already completed the Davis Autism Approach Program, but he was still having a lot of self-esteem issues and agreed to do some TIR with me. There was a particular incident he told me about, saying, “I know exactly when it started, this feeling of not being worthy, not being good enough.” He said it started one day when he was a boy, and he and two cousins were out in a boat fishing. They were so proud and excited to be out in a boat without any adults, and everything was absolutely wonderful, and he loves to fish. They were having a great time when some music came on a portable radio one of the boys had with them, so my client started to sing along and the other two started to laugh.

“What’s wrong?”

They said, “Sing that again.” So he did and they laughed again. They told him he had the words wrong.

He said, “No, I don’t” and they said, “Yes, you do. The words are …” whatever they said.

“No, they’re not!” and a very loud angry argument ensued. He arrived home feeling very frustrated and very angry. He later looked up the words and discovered that his cousins were right. He said he knew then that he wasn’t safe. Up until then, he had always felt safe within his family, which is a large extended and very close family. He said he always knew he wasn’t safe outside the family because of his learning disabilities and his extreme hyperactivity and oppositional behavior (which he now knows was autism). But he had always felt safe within the family. He knew after that boating experience that he wasn’t even safe there. He has carried that feeling with him all these years.

A couple of things happened as we finished up that session. He said that first of all, he had put into words things that he had never ever, ever, ever told anyone; and I think that in itself was probably really wonderful for him. He also said at the end that he thought, “You know, maybe I can do something really good with this. Maybe I can turn it into a funny story and I can amuse people with it and educate them about autism at the same time.” He has since told me about an earlier incident when the feeling of not feeling safe really began. I suspect he is now able to access that event when he couldn’t previously, so I look forward to working on that with him.

Do I have any advice for TIR facilitators wishing to work with autistic clients? At the risk of being very audacious, I would offer this: Be willing to take what little windows of opportunity are presented. I don’t think that it would work to just have someone come in for a TIR session, because they might or might not be in the mood that day — you just don’t know. But if you can, be willing to grab those tiny little windows that can work. Be prepared to follow the client’s lead without necessarily bringing him or her back to the event or the issue originally addressed, because their attention will go all over the place. Don’t be concerned about the seeming lack of ego-strength or engagement. It’s very clear to me now that this can work even if it would appear that we shouldn’t even try. When we’re working with autistic individuals, it’s not uncommon for them to seem to be paying little or no attention to us as we talk with them, walk about with them, or coach them into creating their three-dimensional clay models, the kind of stuff I do every day and you think you’re talking to the wind. Sometimes, they’ll make a clay model, and then smash it, then they’ll make it again and they’ll smash it, then they’ll make it again but change it. But the next day, when they come back, they can totally redo the whole thing and they’ve got the concept. So, you have to work a lot on trust. They do seem to be able to process in a different way and internalize the message even if they appear not to be engaged at all. The bottom line is, TIR and related techniques do work with people on the autism spectrum.

[2] As of late December 2014, he was still doing well in school.